The Differences Between Melasma, Sun Spots, and Other Skin Spots

What’s that brown spot? Here’s how to ID your skin markings and know when they require a visit to a dermatologist.

Brown spots on our skin

Courtesy American Academy of Dermatology

We all have mysterious brown spots on our skin, whether we were born with them or have developed them through the years as a result of sun exposure and aging. Though it’s perfectly normal to be speckled in your own unique way, it’s important to be on top of all of your skin markings so you can determine whether something’s new, growing, or changing in any way—which could be a sign of skin cancer. We asked top dermatologists to give us the 411 on the most common splotches to monitor on your skin in between checkups.

Sun spots

Courtesy American Academy of Dermatology

Caused by (you guessed it) exposure to the sun, these brown spots usually look like freckles, but tend to be larger. “After time in the sun, our cells’ melanin production goes into overdrive trying to combat UV/UB damage,” explains Dendy Engelman, MD, Manhattan-based dermatologist and cosmetic surgeon. “When a cell overproduces melanin, it causes the area to look darker, thus forming a sun spot.” The first step in treating sun spots starts with prevention: limiting exposure, and wearing sunscreen and protective gear. Chemical peels or lasers at your dermatologist’s office can help fade the spots, as well as topical products such as SkinMedica Lytera 2.0 Pigment Correcting Serum, SkinCeutical Advanced Pigment Corrector and DRMTLGY Advanced Dark Spot Corrector.

Moles

Courtesy American Academy of Dermatology

Most of us have at least one or two moles, which are known to vary in size and shape. “Moles can range from a birthmark to a growth that can either be completely benign or ranging from benign to malignant (cancerous),” explains Joel Schlessinger, MD, board-certified dermatologist and RealSelf contributor. There is no surefire way to determine the status of moles without visiting a dermatologist, but many will recommend you use the ABCDE rule: “‘A mole that is not a cause for concern should not be asymmetric, should not have an irregular border, should not be dark in color, should not be larger than the size of a pencil eraser in diameter, and should not be evolving, or changing in any way.” Treatment will depend on the area and whether or not the mole tests as benign or malignant. “Often, a dermatologist will biopsy or remove a mole if there are any concerns,” he says. Read this if you’re thinking of mole mapping.

Melasma

Courtesy American Academy of Dermatology

This condition is the result of hormonal changes within your body, which can be caused by myriad things from pregnancy to birth control. When it is caused by pregnancy, it’s referred to as chloasma, or “the mask of pregnancy”—because of the rather large splotches or areas of darker pigmentation that crop up on the face and neck. “Generally, it appears in women in their 20s, but can appear at any age and affect men as well,” says Dr. Schlessinger. While lasers are sometimes recommended for treating melasma, Dr. Schlessinger notes that they often only make the pigmentation worse. His favorite over-the-counter treatment is the Obagi Nu-Derm products combined with tretinoin. “There are other prescriptions such as 4% hydroquinone and Retin-A that have been used with great results, but only if the individual stays out of the sunlight without fail,” he says. ” There’s no best treatment for melasma, because needs are different based on the type and severity of skin damage, the pigment of your skin, and how much downtime you’re willing you tolerate.” If you’re concerned about your melasma, make an appointment with your dermatologist for a treatment plan that is customized to your skin-care needs.

Birthmarks

Courtesy American Academy of Dermatology

You’re probably the most familiar with this type of brown spot, which shows up at birth or develops within the first few weeks of life. “Birthmarks are a collective term that includes spots ranging from moles to port wine stains (a vascular growth), hemangiomas (another vascular growth) to serious congenital nevi (larger moles),” explains Dr. Schlessinger. Treatment of birthmarks depends on the type. Port wine stains, for example, can be treated with laser; hemangiomas are treated with either a drug called propranolol or observation (or, rarely, steroids); and darker spots, such as nevi or congenital nevi, are treated depending on the area, size, color, and family history. If you’re not sure whether a mark is a birthmark or mole, visit your dermatologist. “Most moles that are present at birth are more of a concern in terms of changes over time, so it is important to note (and photograph) which ones are present at birth or shortly thereafter in order to clearly document them,” he adds. These are the sneaky places you can get cancer that aren’t your skin.

Freckles

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Many people consider freckles to be a natural skin variation, but these tiny light-to-dark brown spots are markings just like any others. “Freckles are most commonly found on children and teens, likely because of their high degree of sun exposure, and they tend to crop up on sun-exposed areas of the face, decolletage, shoulders, and body,” explains Lara Devgan, MD, a New York City-based plastic surgeon. While freckles are usually harmless, they can become precancerous when exposed to too much sun. If you are trying to get rid of existing freckles, Dr. Devgan recommends starting with topical skin products, specifically retinoid creams and high-potency vitamin C serum. “Lasers can also help, but a medical grade skin=care regimen is both less invasive and less expensive, so that would be my first line approach.” Top vitamin C serums include iS Clinical Pro-Heal Serum Advanced Plus, DermaDoctor Kakadu C 20% Vitamin C Serum with Ferulic Acid and Vitamin E, and DRMTLGY Advanced C E Ferulic. Here’s what having eye freckles means for your health.

Age spots

Courtesy American Academy of Dermatology

Similar to freckles, age spots appear on sun-exposed skin as a result of age plus UVB exposure. They are sometimes referred to as liver spots, but Dr. Devgan points out that they actually have no relationship to the abdominal organ. “Age spots are generally benign, but because of their variable appearance, they can sometimes make skin cancers more challenging to detect,” she says. The best way to treat age spots is to do your best to avoid getting them in the first place: by minimizing sun exposure and always wearing a high quality sunscreen. “Treatment options for age spots include topical hydroquinone, azelaic acid, vitamin C, and retinoids, as well as more invasive options like laser therapy and cryosurgery,” says Dr. Devgan. Read more about how dermatologists treat age spots.

Vitiligo

Courtesy American Academy of Dermatology

This skin disorder is the exact opposite of most skin spots. Vitiligo is not brown, but rather white, or lacking in pigment. It is common in young individuals, but it can appear at almost any age, most often on areas of the hands, feet, and face. “There aren’t many lookalikes to this condition, though some conditions such as a fungus infection can mimic it,” explains Dr. Schlessinger. “If there are spots that range from a half-inch to an inch or so and don’t have pigment, this is likely to be the cause.” While there are many treatments available, most do very little to truly treat the problem. “Over-the-counter treatments include steroids, such as FixMySkin Healing Body Balm with 1% Hydrocortisone, or various lasers—Excimer is one that we use in our office,” says Dr. Schlessinger. Read more about how to treat white spots on your skin.